..Past Projects
PAST PROJECTS: DIABETES PROJECTS
- AIM@GP – Advancing INSIGHT Methods in General Practice: Insulin Initiation Support in Primary Care
- CANOE - CAnadian Normoglycemia Outcomes Evaluation Expanding the CIRCLE
- Expanding the CIRCLE
- The Development of Educational Strategies for Family Physicians in the Use of Physcical Activity and Dietary Counselling in the Prevention and Control of
Type 2 Diabetes
- The Impact of Cost-Effectiveness of Point-Of-Care Testing on the Management of Patients with Type 2 Diabetes in a Group Family Practice Setting
- Teleconferenced Educational Detailing (TED) - An Innovative CME Program for Family Physicians to Enhance the Management of Patients with
Type 2 Diabetes
- Family Physician Group Practice Consensus: A Method to Disseminate Practice Guidelines
- An Innovative Strategy for Family Physicians in the Dissemination of New Clinical Practice Guidelines fot the Management of Type 2 Diabetes Mellitus (NIDDM)
1 - AIM@GP – Advancing INSIGHT Methods in General Practice: Insulin Initiation Support in Primary Care |
Abstract: The objective of the AIM@GP study was to determine the effectiveness of an insulin initiation strategy to increase family physician (FP) insulin prescribing using a stratified, parallel group, randomized controlled design.
Family physicians from across Canada were recruited. All FPs received education focusing on insulin initiation and titration, a summary of the current glycemic management of their patients, and a list of patients who would benefit from insulin prescription. The insulin initiation strategy consisted of the option to refer patients to a trained community pharmacist for a 1-hour patient insulin initiation session; consultation support by a diabetes specialist and diabetes educator. This study did not increase insulin initiation in family practice more than an educational workshop and usual practice.
2 - CANOE - CAnadian Normoglycemia Outcomes Evaluation |
Abstract: The CANOE study was a double-blind, randomised controlled trial that investigated whether low-dose combination therapy would affect development of type 2 diabetes. Implemented in Toronto and London, the trial assigned 207 participants with impaired glucose tolerance to receive combination rosiglitazone (2 mg) and metformin (500 mg) twice daily or matching placebo for a median of 3.9 years. Incident diabetes in the active treatment group was 14%, significantly less than in the placebo group at 39%. The relative risk reduction was 66% and the number needed to treat was 4. Low-dose combination therapy with rosiglitazone and metformin was highly effective in the prevention of type 2 diabetes in those with impaired glucose tolerance.
3 -Expanding the CIRCLE |
Abstract: The primary purpose of the Expanding the CIRCLE project was to build research capacity among young, talented, Aboriginal students. The students would learn to conduct health services research, including knowledge translation, and build on their knowledge of diabetes while performing a research study to determine the drivers of high quality diabetes care on reserve.
The project had two phases. In Phase I two Aboriginal students were hired and trained in health services research, qualitative research methods, and knowledge translation. Specific responsibilities included developing the research protocol and recruiting communities and obtaining informed consent. In Phase II the protocol was implemented. Qualitative interviews with community leaders, healthcare providers, and community members with diabetes were conducted and diabetes care processes were observed in four First Nations communities. The students reported on the key findings: (1) communication was identified as a key issue by all participants; (2) professional development and cultural awareness training; (3) the importance of the social determinants of health i.e. housing, food security, poverty etc.; (4) access to primary healthcare; and (5) a stronger connection between traditional healing and medicines and the current primary healthcare systems in place. The Expanding the CIRCLE project was proven to be a successful method to build research capacity in engaged Aboriginal students.
4 - The Development of Educational Strategies for Family Physicians in the Use of Physcical Activity and Dietary Counselling in the Prevention and Control of Type 2 DiabetesFunding Source:Health Canada/Canadian College of Family Physicians |
Abstract: The project will examine the educational needs of family physicians and will explore effective diabetes prevention programs, interventions and current educational programs for health professionals. Strategies will then be developed to:
- Promote tools and disseminate information for family physicians in the use of physical activity and dietary counselling in the prevention and/or control of type 2 diabetes,
- Explore and link up with other organizations, such as the Dieticians of Canada, and combine promotional efforts targeting diet and physical activity in the area of prevention and/or control of type 2 diabetes.
- Leverage existing CFPC partnerships with organizations such as the Canadian Fitness and Lifestyle Research Institute (CFLRI), the Active Living Coalition for Older Adults (ALCOA) and The Foundation for Active Healthy Kids to more effectively reach project goals.
For further information please contact Dr. Stewart Harris
5 - The Impact of Cost-Effectiveness of Point-Of-Care Testing on the Management of Patients with Type 2 Diabetes in a Group Family Practice SettingFunding Source: Medical Research Council/Rx&D Research Program |
Abstract: The 1998 CDA clinical practice guidelines (CPGs) recommend ongoing evaluation of glycemic control & screening for complications. The availability of more immediate laboratory results (Point-of-Care testing) carried out during the physician-patient encounter may influence patient treatment/adherence as well as affect overall costs to health care system. Point-of-Care (POC) has been defined as "any investigation carried out in a clinical setting or the patient's home for which the result is available without reference to a laboratory & rapidly enough to affect patient management". Currently, there is a paucity of research studying the effectiveness of POC technology in community-based family practice. Purpose: to evaluate the effect of POC technology on the management of patients with type 2 diabetes mellitus (type 2 DM) in family practice group settings. Objective: to examine the effect of 2 POC machines: (1)DCA 2000® System for glycated haemoglobin (HbA1C) testing & (2) Clinitek® 50 Urine Chemistry Analyzer System for albumin:creatinine ratio (a:c ratio) on the care of patients with type 2 DM including a cost-effectiveness evaluation. Design: a cluster-randomized, controlled trial will be used to evaluate the intervention. Research will be performed in a maximum of 8 consenting group family practice sites (4-6 physicians/group) in Southwestern Ontario. Intervention: The Clinitek® 50 and the DCA 2000® together will be randomly allocated into half of the practices. The intervention will last 12 months. Measures: The primary outcome measure will be glycemic control as measured by HbA1C values. Secondary measures include: frequency of HbA1C testing; patient compliance, communication and satisfaction; proportion of patients tested for HbA1C & screened for nephropathy; adherence to the other CPG recommendations; & net health benefits. Rationale: management of type 2 DM, will benefit from the immediate feedback that POC testing offers. With POC technology providing faster results, the management of patients with type 2 DM may be improved. Formal evaluation is needed to best determine its optimal role in community-based family practice.
For further information please contact Dr. Stewart Harris
6 - Teleconferenced Educational Detailing (TED) - An Innovative CME Program for Family Physicians to Enhance the Management of Patients with Type 2 DiabetesFunding Source:SmithKline Beecham Pharma |
Abstract: The complexity and chronic nature of diabetes presents special challenges for family physicians. Adherence to clinical practice guidelines (CPGs) is reported to be low to moderate. One of the primary barriers to diabetes management is effective educational strategies and the time factor for learning.
The purpose of this Canadian project is to evaluate the impact of a Teleconferenced Educational Detailing Continuing Medical Education program (TED) on diabetes management in primary care.
A cluster-randomized, controlled trial, stratified by regional site, will be used to evaluate the intervention. One hundred and fourteen family doctors are participating as the principal investigators in the REACT2 Diabetes study. This is a phase IV clinical trial evaluating the oral insulin resistance reducing agent, Avandia™. These family doctors have the opportunity to volunteer to participate in TED.
The intervention in this study will include 8 1-hour, small-group educational sessions consisting of topics relating to diabetes management (Diagnosis and Classification, Screening, Microvascular Complications, Cardiovascular Complications, Elderly, Oral Medications, Insulin, and Office Strategies). The first session will be face-to-face and the next 7 sessions will be held via teleconference. The majority of the time will be spent on individual case discussions. Diabetes specialists in each geographic region will facilitate the case-based discussion.
Outcome measures will include: patient quality of life and physician knowledge questionnaires, chart audit focussing on glycemic control and the prevention of diabetes-related complications. Therefore, this evaluation within the REACT2 Diabetes study will assess the impact of TED on improving the management of type 2 diabetes using the objective clinical endpoints together with patient focused outcomes and quality of life.
For further information please contact Dr. Stewart Harris
7 - Family Physician Group Practice Consensus: A Method to Disseminate Practice GuidelinesFunding Source: MRC/PMAC (Medical Research Council of Canada/Pharmaceutical Manufacturers Association of Canada) |
Abstract: In 1998, an Expert Advisory Committee from the Canadian Diabetes Association (CDA) published clinical practice guidelines (CPGs) for primary care physicians to promote comprehensive care/effective management of patients with type 2 Diabetes Mellitus (DM).
Traditional guideline dissemination techniques have demonstrated limited effectiveness. Alternative strategies including academic detailing/systematic changes introduced in the office setting have been shown to affect change in practice. Enhancing the use of guidelines by primary care physicians has potential to improve health of patients with type 2 DM. Objective: Develop a model to facilitate dissemination/implementation of CDA 1998 CPGs. Evaluate the effectiveness of the model to: increase the level of knowledge of CPGs within the group practice setting, increase adherence of the CDA 1998 CPGs within the group practice setting, and facilitate the utilization of the CDA 1998 CPGs within the office management system. Method: A pre-post wait listed, randomized control trial will be used to evaluate the model. Subjects will be family physicians in a group setting, their staff/patients with type 2 DM. There will be 4-group practice per study location. Main outcome measures are: physician knowledge of CDA guidelines (Physician Knowledge and Practice Survey), the Physician type 2 Diabetes Management Questionnaire; physician adherence to guidelines (chart audit); patient glycemic control using HbA1c (chart audit); office management audit (Office Management Questionnaire). Ten charts per physician will be randomly chosen from consenting/eligible patients. All baseline measures will be re-applied 6-months and 12-months post-intervention. The intervention include: an intensive, 1/2-day, small group, case-based, CME session with an expert peer (site investigator) highlighting the new CDA CPGs; individual results of the audit in a confidential summary; a summary of the group practice audit results; a 1/2-day strategy session with office staff to focus on office efficiency strategies for the management of patients with type 2 DM.
For further information please contact Dr. Stewart Harris
8 - An Innovative Strategy for Family Physicians in the Dissemination of New Clinical Practice Guidelines fot the Management of Type 2 Diabetes Mellitus (NIDDM)Funding Source:Canadian Diabetes Association |
Abstract: In 1998, an Expert Advisory Committee from the Canadian Diabetes Association (CDA) published clinical practice guidelines (CPGs) for primary care physicians to promote comprehensive care and effective management of patients with type 2 Diabetes Mellitus. The 1998 CDA CPGs reflect the most recent evidence that tight control of glycemia reduces the long-term complications of this disease. The benefits generally associated with CPGs include dissemination of evidence-based information related to practice, reduced variation in clinical practice, improved quality of care, and, reduced health care costs. The current literature on practice behaviour, however, indicates CPGs are not widely applied in day to day practice. New dissemination strategies are required if we are to improve the implementation of CPGs. Traditional guidelines dissemination techniques (such as CME presentations) have demonstrated limited effectiveness. In contrast, alternative strategies including academic detailing and systematic changes have been shown to affect change in practice.
The purpose of this study is to develop and evaluate an innovative multi-faceted model for dissemination of the new 1998 CPGs. Using a randomized control design, family physicians currently participating in the "Family Physicians' Practice Patterns and Experience in the Management of type 2 Diabetes Mellitus" research study will be allocated to an experimental or control group. Physician knowledge, physician practice patterns and patient glycosylated haemoglobin will be used as outcome measures.
Expanded use of these guidelines by primary care physicians has the potential to improve the health of patients with type 2 Diabetes Mellitus.
This current study will partially fund the research coordinator and secretary in the proposed budget.
For further information please contact Dr. Stewart Harris
Also from this web page:
